Group #1: Jamie Newman (USA); Guilherme Barcellos (Brazil); Andrés Aizman (Chile); Fernando Rivera (USA); Luiz Rojas Orellana (Chile); Neil Winawer (USA); Esteban Gandara (Canada); Jairo Roa (Colombia)

Group#2 (2010-now): Guilherme Barcellos (Brazil); Jamie Newman (USA); Andrés Aizman (Chile); Daniel Grassi (Argentina); Fernando Rivera (USA); Luiz Rojas Orellana (Chile); Roberto Daniel Martinez (Argentina); Lucas Zambon (Brazil); Neil Winawer (USA); Esteban Gandara (Canada); Fabiana Rolla (Brazil)

Tuesday, February 1, 2011

Will we be replaced by hospitalist “midlevel” providers?

Considering the fact that some hospital administrators have a tendency to view hospitalists as floaters who fill in for other physicians.

We know that the role of the hospitalist is more than being on-site as a “super resident” processing patients for other physicians or as a “nurse's doctor of convenience”, but...
Brazil is champion in absolute number of medical schools and we have a profession in crisis: too many doctors - lots of dysfunctional competition - low salaries;

In Brazil we can’t use midlevel providers.

My fear in that [bad] hospitals in Brazil start to use young licensed doctors as “midlevel hospitalists”. A physician assistant in the US is a healthcare professional licensed to practice medicine with supervision of a licensed physician. There is a movement here to have a licensed physician (not medical resident anymore) working for hospitals and attending physicians giving rear to the traditional model. Some hospitalist programs start because of the increasing necessity of around-the-clock doctors at the hospitals, but to be just for the attending physicians’ temporary substitution, what adds another layer of costs, perhaps duplication...

Will we be replaced by hospitalist “midlevel” providers?

Hope comments could help us...


  1. Luciano Grohs2/17/2011 5:36 PM

    Well pointed, Guilherme. Indeed, it's already going on. "Hospitalist" job offers in Brazil mainly are positions of taking care of post-anesthetic rooms or doctor on call, for attending nurses' call. Sometimes, the offer is for "RRT" also (in this case can be the guy who can be called but is located in the ER, a MD jack of all-trades. It is very hard to convince a hospital of hiring real hospitalists for integral care, but at least there is a positive point: the word "hospitalist" is sounding around us.

  2. For the patients, care could become more duplicated or flawed or completely uncoordinated. It could produce a cacophony of incomplete decision and overlooked errors. Costs will increase! See what Wachter, Percelay and others think about it at the SOBRAMH's website:

  3. I understand your point of view. I am from Brazil and I am 5 months away from graduating from the Physician Assistant Program. Here in the United States we have the opposite situation with not enough healthcare providers and rural/underserved areas in need for doctors, PAs and nurses. PA is the second best job according to Forbes Magazine and there are so many jobs around. I also think that some of the hospital conditions in Brazil are so bad, not enough beds, equipments...but the only way I can update myself about the healthcare system in my home country is reading blogs like this one.

    1. Ana Paola,
      my name is Ana Elisa, I am also from Brazil and I'm applying for PA school next March. I have 2 more pre requisites to finish and a couple of tests, like the TOEFL. I'd like to talk to you about the PA school, the course, and the challenges that you faced. I am trying to know as much as I can before the interview.
      I am very happy to know you are about to be a PA, you are the first Brazilian PA I heard of!
      Please write me an email if it's ok with you, or any other sort of way I could contact you, like phone or facebook, whatever you prefer.
      I'd be very honored to talk to you.
      Thank you!

  4. My name is Angelica and I am a practicing PA-C since 2008. I would like to call for all the brazilians interested in making our profession knowon and understood in Brasil. I strongly believe that we can help fill the gap there. There is a huge need for Practictioners in the primary care specialty even though there are too many doctors. WE could help improve the health care system through the extension of care to the most needy towns, villages etc.
    I would like to discuss that more with anyone intersted in it...
    I am on facebook and my email is